Outcome of cyclosporine rescue therapy or surgery in patients with steroid-refractory ulcerative colitis: both improve the quality of life despite of the frequent complications

Introduction: Patients with ulcerative colitis (UC) usually can not accept the need for colectomy; however rescue therapies may cause severe side-effects. The aim of our study was to compare the outcome and the changes of quality of life in patients with steroid-refractory UC before and after cyclosporine rescue therapy or colectomy. Patients and Methods: Data of 90 steroid-refractory UC patients were analyzed retrospectively, of which 46 patients underwent colectomy and 44 patients responded to cyclosporine therapy. Every patient assessed their quality of life at the time of the diagnosis of UC, three month before and half year after cyclosporine introduction/colectomy and at their last visit. The number of hospitalizations, outpatient visits, and medication used before and after the surgical or conservative treatment were compared. Results: 74% of the colectomized patients underwent ileal pouch anal anastomosis procedure. Early complications occurred in 52.1% of the patients. Frequency of the in – and outpatient visits, and the number of medications decreased significantly after colectomy (p<0.001). Quality of life improved significantly even in the first 6 months after the surgery vs. the preoperative period. Patients with pouchitis also assessed their quality of life significantly better after the colectomy than at the time of diagnosis (p<0.001). Adverse events occurred in 88.9% of the cyclosporine treated patients and led to treatment discontinuation in 20.9% of the cases. The frequency of the in – and outpatient visits, and the number of medications did not decrease significantly after the introduction of cyclosporine. Quality of life improved significantly after 6 months of cyclosporin therapy vs. at the time of the diagnosis and 3 months before the initiation of the therapy (p<0.001). Interestingly, patients who underwent colectomy revealed significantly better quality of life at 6 months than those who received the drug (p=0.001). Conclusion: Although our data show that both cyclosporine rescue therapy and colectomy can result in a good quality of life in patients with acute severe UC, frequent side-effects of cyclosporine and the need for maintenance immunosuppression or the common postoperative complications indicates that there is still need for better therapeutic tools.